The effect of hospital characteristics and organizational factors on pre- and postoperative lengths of hospital stay

Abstract

To determine reasons for variations in length of stay (LOS) for surgical patients, a comprehensive statistical model was specified and estimated using 1978 discharge abstract data from New Jersey. The model distinguished preoperative LOS from postoperative LOS, and analyzed differences in the impacts of each determining factor on each segment of a hospital stay. The model included a large set of control variables, but the focus of discussion in this article is on factors which reflect the preferences, policies, and organizational routines of hospitals. The empirical findings suggest strategies that hospital managers and regulators can use for reducing average LOS. For example, afternoon admissions often result in extra preoperative days of care even after adjusting for severity of illness. Apparent scarcity of posthospital care in New Jersey also seems to translate into longer hospital stays. Using a comprehensive model and a large, reliable data set, the analysis confirms many hypotheses concerning reasons for LOS variation that have been suggested by earlier research. However, the analysis also raises questions concerning the interpretation of other earlier findings.